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NPI Code Detail

MEDICARE: EMILY WILSON

MEDICARE: EMILY WILSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1662TN

General Provider Information

NPI Number : 1477154342
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY WILSON
Provider Business Mailing Address
First Line : 1500 S DOUGLAS RD STE 230
Second Line :
City : CORAL GABLES
State : FL
Zip : 33134-4108
Country : US
Telephone Number : 844-244-1818
Fax Number :
Provider Business Practice Location Address
First Line : 206 S JEFFERSON AVE
Second Line :
City : COOKEVILLE
State : TN
Zip : 38501-4748
Country : US
Telephone Number : 931-283-2919
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2020
Last Update Date : 11/01/2024

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